The development of disseminated intravascular coagulation in hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP) at very early gestational age.

Hemolysis, elevated liver enzymes, and low platelet count syndrome(HELLP) is a severe pregnancy complication since it is life-threatening for both mother and fetus. When HELLP syndrome associates with disseminated intravascular coagulation (DIC) or with other complications it is necessary to terminate the pregnancy; however, due to fetal prematurity, it may be advisable to wait for the effectiveness of the corticosteroid prophylaxis of neonatal respiratory distress syndrome when such complications are not present. This article reports an initially mild HELLP syndrome case, with onset at week 26 and two days of pregnancy, where it was necessary to wait for the effectiveness of respiratory distress prophylaxis and, consequently, to carry out a close monitoring of the onset and worsening of DIC. Tests for blood cell distribution width, D-dimer, plasmatic electrolytes and urinary sediment, which undergo precocious and rapid variations in DIC, are quickly processed, and useful for the conservative management of HELLP.

MASA syndrome: ultrasonographic evidence in a male fetus.

The recent identification of a common etiology among MASA syndrome (McKusick 303300), X-linked hydrocephalus (HSAS) (McKusick 307000) and other related neurological disorders, which had previously been considered distinct nosological entities, allowed us to diagnose MASA syndrome in a male fetus in a primigravida at the 29th week of gestation by sonographic signs of the MASA spectrum such as hydrocephalus and hypoplasia of corpus callosum. Indeed, the evidence of an X-linked neurological disease in the brother and the maternal uncle of the pregnant women enabled us to estimate a 25% risk of a male fetus being an affected hemizygote. The way in which a prenatal diagnosis, based on instrumental procedures, was reached is described since the authors were unable to perform, at the time of the observation, a molecular confirmation which was carried out only after birth.

[Giant pedunculated clustered uterine fibromyoma in hyaline and cystic degeneration. Limitations of clinical and instrumental diagnosis]. / Fibromioma uterino gigante peduncolato a grappolo in degenerazione ialina e cistica. Limiti della diagnostica clinica e strumentale.

The authors report a case of a 46-year-old woman who was checked by integrated ultrasound examination, i.e. transabdominal and transvaginal, and by abdominopelvic CAT. The examinations, ascertained the presence of a probably malignant, voluminous, ovarian, multilobate abdominopelvic neoplasia. On opening the belly, it was found that the tumefaction was a voluminous, pedunculate uterine myofibroma in clusters starting from the rear isthmian wall while the adnexa were normal. The histological examination confirmed that it was a "fibromyoma in hyaline and cystic degeneration". The authors conclude that although the image diagnostics has reached an extremely high level of precision, it is not yet possible to make an absolutely certain diagnosis, either on the organ from which a pelvic neoplasia originates or on its biological nature.

[Immigrant women and health services. Experience with hospital obstetric-gynecologic department (1992-94)]. / Donne immigrate e servizi sanitari. Esperienza nell'area ostetrico-ginecologica ospedaliera (1992-94).

In order to know more about immigrant women who have applied for obstetrical and gynaecological care and the results of these requests, data on those admitted have been analyzed at the obstetric and gynaecological ward of the general hospital of Perugia during the period from July 1992 to June 1994. The following observations were made: a) African and eastern european women comprised the group that most frequently applied for abortion; b) the percentage of cesarean sections was lower among foreign women than Italians women; c) with respect to average of all immigrant admitted for obstetrical pathologies, the largest group, according to the area of origin, was comprised of women from Africa and it was decided that the quality of obstetrical assistance received by this group should be verified.

[Severe anomaly of fetal limbs after early and failed voluntary interruption of pregnancy]. / Severa anomalia degli arti fetali dopo precoce e fallita interruzione volontaria di gravidanza.

The authors report the case of a patient who underwent a failed legal abortion at the 7th week of pregnancy via vacuum aspiration. A follow-up ultrasound survey done at the 14th week demonstrated the continuance of pregnancy and the presence of a serious fetal deformity consisting of the amelia of the two upper limbs, complete phocomelia of the right lower limb and distal phocomelia of the left lower limb. In the light of recent findings of a high incidence of fetal limb abnormalities in women subjected to chorionic villus sampling, before the 9th week of gestation, the Authors hypothesize that chorionic villus sampling, occurring during the abortion attempt, could probably be the cause of the fetal limb abnormalities in the present case study.

[Pregnancy and labor in a primigravida with Glanzmann's thrombasthenia]. / Gravidanza e parto in primigravida affetta da tromboastenia di Glanzmann.

Glanzmann's thrombasthenia is an autosomal, recessive, inherited haemorrhagic disorder due to the lack of the glycoprotein IIb/IIIa (GP IIb/IIIa) complex of the platelet membrane. The disease is characterized by a prolonged bleeding time and by a severe haemorrhagic mucocutaneous diathesis. The only possible antihaemorrhagic therapeutic measure is the infusion of platelet concentrates, but this is almost constantly associated with the production of antibodies against the GP IIb/IIIa complex that lead to the rapid removal of the infused platelets from the circulation. For this reason, platelet transfusions are usually without efficacy and must be limited to severe, profuse haemorrhages. We report the case of a primigravidae with Glanzmann's thrombasthenia in which a spontaneous delivery was made possible by a series of measures taken during the parturition to avoid haemorrhagic complications, without the use of platelet transfusions.

[Post-menopausal metrorrhagia. Use of danazol in endometrial hyperplasia]. / Metrorragia post-menopausale. L'uso del danazolo nella iperplasia endometriale.

The Authors, after a careful examination of the literature on endometrial hyperplasias, review the results of a preliminary study on 15 patients affected with postmenopausal metrorrhagia, cured by Danazol (200 mg/die) through 90 consecutive days. Also recognizing the best tolerance to the drug and the low incidence of the side effects, they think the results obtained by Danazol need further confirmation by more protracted controls.

Ontogeny of CA 125 antigen in pregnancy: immunoradiometric determination in amniotic fluid and immunohistochemical localization in fetal membranes.

CA 125 antigen was measured in amniotic fluid, maternal blood, cord blood, and fetal urine by a commercially available immunoradiometric assay kit. The amniotic fluid was obtained from 99 normal pregnancies at various gestational ages. The mean antigen levels were 29,676, 3350, and 1680 U/ml in amniotic fluid of the first, second, and third trimesters, respectively. In maternal blood, 12.5% of pregnant women in the first trimester of pregnancy showed elevated levels of CA 125 (65 to 100 U/ml). Late in gestation, CA 125 levels in cord blood and fetal urine were always less than 65 U/ml. Immunohistochemical study of CA 125 in fetal membranes, placenta, and decidua showed the presence of antigen only in the amnion. These results suggest that CA 125 is shed into amniotic fluid directly from the amniotic membrane.

Ultracytochemical localization of guanylate cyclase in early human placenta.

Previous biochemical and cytochemical studies have indicated that in human term placenta the enzyme guanylate cyclase (GC) is associated mostly with the cytosolic fraction of homogenates and localized on the syncytiotrophoblast microvillous border. In the present study we have shown cytochemically the GC particulate form in early human placenta using guanylyl-imidodiphosphate [Gpp(NH)p] as substrate and NaN3 as activator. In samples of placental villi taken from the 6th to 12th week of pregnancy, the GC reaction product was always found on the apposing Langhans cytotrophoblast and syncytiotrophoblast plasma membranes. Furthermore, GC was present on cells in mitosis of the Langhans cytotrophoblast. From the 11th week GC was also visible on basal plasma membranes of Langhans cytotrophoblast and on endothelial cells of fetal capillaries. In samples of human term placenta GC was detectable on the syncytiotrophoblast microvillous border. This suggests a shift of enzyme localization during pregnancy.

Ultracytochemical localization of adenylate cyclase in early human placenta.

A cytochemical study was carried out on adenylate cyclase (AC) activity in the early human placenta. Samples of placental villi were incubated in a medium containing adenylyl-imidodiphosphate (AMP-PNP) as specific substrate. No AC reaction product was encountered in placenta villi taken at 5 and 7 weeks of pregnancy. AC activity appeared at 9 weeks. At 9 and 10 weeks, AC reaction product was localized on the basal plasma membranes and on apposed plasma membranes of the Langhans cytotrophoblast. At 11 weeks AC activity was also clearly visible on Langhans cytotrophoblast and syncytiotrophoblast apposed plasma membranes. No AC reaction product was ever detected on the syncytiotrophoblast microvillar membrane. These results are in agreement with biochemical studies that localize AC on the villous trophoblast plasma membranes associated with the fetal circulation.